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Ask the doctor.

Q What is borderline personality disorder, and how is it treated?

A Borderline personality disorder (BPD) is also known as emotional dysregulation disorder. It is a serious mental illness that affects up to 2 percent of adults--mostly women--and accounts for 20 percent of psychiatric hospitalizations. This personality disorder is characterized by great instability in behavior, self-image, moods and interpersonal relationships. People with BPD display impulsive behavior, reactive and intense moods, poor self-image, and feelings of loneliness, emptiness and boredom. They may engage in extreme "black and white" thinking, and experience frequent bouts of inappropriate intense anger and mood swings between love and hate. They often view themselves as victims of circumstance, and may have a deep fear of abandonment. They are likely to engage in risky or self-destructive behaviors, such as drug use, obsessive eating, and reckless driving, or they may deliberately injure themselves through self-mutilation, cutting or overdosing. They are also more likely to attempt suicide. The cause of this disorder is not clear, although there is evidence it may be associated with abuse or neglect in childhood, or with genetic factors that heighten vulnerability to stress or loss. In some cases, people who suffer from mood disorders such as major depressive disorder and bipolar disorder may experience symptoms that could mimic those of BPD, except that these symptoms tend to abate when their mood disorder remits. Patients with BPD can be challenging to treat because of their long-standing coping patterns and difficulties with authority figures. Treatment involves psychotherapy, often in combination with group therapy. Dialectical behavior therapy (DBT), a form of therapy that teaches patients to control their emotions and avoid self-destructive behavior, has proven to be especially effective. Medication may be used to treat symptoms such as depression, anxiety and mood swings, but no single medication is clearly helpful in BPD.

Q My friend's 53-year-old wife began behaving oddly a year or so ago, and since then her personality has changed dramatically. A specialist has diagnosed her with a kind of dementia called Pick disease. Can you please tell me more about this disease?

A Pick disease is a relatively rare form of dementia about which very little is known. It is more common in women than in men and usually develops in middle age (40 to 60 years). Because this progressive neurodegenerative disease affects nerve cells in the frontal and temporal lobes of the brain, causing them to shrink, it is often grouped together with other non-Alzheimer dementias under the category of Frontotemporal Dementia. Pick disease is characterized by the accumulation of Pick's bodies, a collection of cell parts that includes abnormal amounts and forms of a protein called tau. Onset is characterized by symptoms such as behavior and mood changes, changes in eating habits, and language difficulties. In the later stages of the disease, patients display neurological symptoms, including cognitive problems such as memory loss and difficulty with reasoning and problem-solving, attention difficulties and muscle rigidity. Over time, Pick disease tends to cause severe brain damage, and patients may lose the ability to care for themselves. The disease is often terminal within 2 to 10 years, with an average survival time of 7 years after diagnosis. There is currently no cure for Pick disease, but there are treatments that may ease certain symptoms and improve behavior and mood. These include avoiding medications that may contribute to confusion or aggression, providing speech therapy for language difficulties, using behavior modification to help the patient control behavior, and treating physical or mental conditions--such as thyroid problems or depressive disorders--that might make mental confusion worse.


Maurizio Fava, MD
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Author:Fava, Maurizio
Publication:Mind, Mood & Memory
Date:Jul 1, 2006
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